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Axonal Injury in Stroke: A Forensic Neuropathology Perspective.

James Mackintosh MacKenzie¹

¹From the Department of Pathology, University Medical School Foresterhill, Aberdeen, United Kingdom.

The American Journal of Forensic Medicine and Pathology

|August 13, 2015

Summary

Beta-amyloid precursor protein (β-APP) staining is used to detect traumatic axonal injury. However, this study found similar β-APP patterns in stroke cases, complicating trauma assessment.

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Area of Science:

Neuropathology
Forensic Science
Neuroscience

Background:

Beta-amyloid precursor protein (β-APP) immunocytochemistry is standard for assessing traumatic axonal injury.
Axonal injury can result from causes other than trauma, notably ischemic injury due to brain swelling or hemorrhage.
Distinguishing trauma-specific β-APP patterns from those in hypoxia-ischemia remains challenging due to limited systematic studies.

Purpose of the Study:

To investigate β-APP immunostaining patterns in stroke cases without head injury.
To determine if β-APP patterns in ischemic or hemorrhagic stroke are distinguishable from trauma-induced patterns.
To evaluate the reliability of β-APP staining in diagnosing traumatic axonal injury when ischemia is a factor.

Main Methods:

Analysis of β-APP immunostaining patterns in 96 stroke cases with no history of head injury.
Comparison of observed staining patterns with those previously attributed to traumatic axonal injury.
Systematic review of literature on β-APP immunoreactivity in trauma versus ischemic conditions.

Main Results:

Complex β-APP staining patterns were observed in stroke cases.
Some observed staining patterns in stroke were indistinguishable from those reported for traumatic axonal injury.
The study highlights significant overlap in β-APP immunoreactivity between traumatic and ischemic axonal injury.

Conclusions:

The findings question the specificity of β-APP immunostaining for traumatic axonal injury.
A cautious approach is needed when interpreting β-APP staining in head injury cases.
Ischemia must be excluded before attributing axonal injury solely to trauma based on β-APP patterns.